Outcomes of Aortoiliac Occlusive Disease Treated by Aorto-femoro-popliteal and Distal Bypass Surgeries: A Prospective Cohort Study
Published: March 1, 2024 | DOI: https://doi.org/10.7860/JCDR/2024/68907.19133
Mohan Lakshmidharan, R Shivali
1. Assistant Professor, Department of Vascular Surgery, Sri Ramachandra Medical College, Chennai, Tamil Nadu, India.
2. Associate Professor, Department of Pharmacology, Madha Medical College, Chennai, Tamil Nadu, India.
Correspondence
Dr. Mohan Lakshmidharan,
Assistant Professor, Department of Vascular Surgery, Sri Ramachandra Medical College, Chennai-600116, Tamil Nadu, India.
E-mail: drsailakshmidharan@gmail.com
Introduction: Aortoiliac occlusive disease can contribute to lower extremity ischaemic symptoms requiring intervention. Though proximal aorto-femoral bypass surgery has been the mainstay of intervention, the delayed healing in many patients necessitates exploration of other techniques, including sequential revascularisation.
Aim: To estimate the outcomes of aortoiliac occlusive disease treated by aorto-femoro-popliteal and distal bypass surgeries.
Materials and Methods: A prospective cohort study was conducted to determine the treatment outcomes of 25 patients with aortoiliac occlusive disease visiting a tertiary care centre of Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India from October 2012 to December 2014. Data regarding the aetiology of the disease, co-morbidities including substance use, degree of disease involvement, and treatment modalities were collected. Data was analysed by Statistical Package for Social Sciences (SPSS) software version 22.0. The Chi-square test was used to compare outcomes with different treatment modalities, and a p-value <0.05 was considered statistically significant.
Results: The mean age of the study participants was 58.3±2 years (range 40 to 70 years). The study noted that the most common aetiology for aortoiliac occlusive disease was atherosclerosis in 18 (72%) cases. The most common associated co-morbidity was smoking in 18 (72%) cases. Abnormal profunda patency was noted in 15 (60%) cases and synthetic Polytetrafluoroethylene (PTFE) was used in 80% of sequential bypass cases. A significantly higher proportion (86.7% vs 30%) of people treated by the sequential procedure achieved relief from claudication pain (p-value <0.05). The complication noted after the proximal bypass was pseudoaneurysm (20%), and the only complication noted after the sequential bypass was graft thrombosis (13.33%). The mean Ankle-brachial Index (ABI) score and ulcer healing time were also significantly higher in the sequential bypass procedure (p-value <0.05).
Conclusion: Sequential bypass offers better advantages than proximal bypass for treating aortoiliac occlusive disease. It was found to be a safe and effective method for successful limb salvage, ensuring successful limb revascularisation and sufficient outflow to maintain graft patency.
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